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Title Page
CHAPTER ONE
CHAPTER TWO
CHAPTER THREE
CHAPTER FOUR
CHAPTER FIVE
CHAPTER SIX
CHAPTER SEVEN
CHAPTER EIGHT
CHAPTER NINE
CHAPTER TEN
PART TWO - THE LYMPHATICS
OF THE CHEST.
CHAPTER ELEVEN
PART TWO - LYMPHATICS
OF THE EYE AND EAR.
CHAPTER TWELVE
CHAPTER THIRTEEN
CHAPTER FOURTEEN
CHAPTER FIFTEEN
APPLIED ANATOMY OF THE
LYMPHATICS
Edited By
Published under the Auspices of the
THE JOURNAL PRINTING COMPANY
R. M. Ashley, D. O.
[ILLUSTRATION: Thoracic Duct]
Realizing that we are writing upon a subject that
in some respects is new to the world, we enter upon the discussion of the
lymphatic system in a spirit of respect for the field of thought that reflects
research activity. As far as we know, this is the first comprehensive
attempt that has been made to outline a method of diagnosis by palpation
of the lymph nodes of the body. We desire in this treatise to emphasize,
first, the applied anatomy of the lymphatics, second to demonstrate the
possibility of determining the stage diseased organs and tissues are in
through a method of palpation of lymph nodules at strategic points, and
third to outline a method of clearing the system of toxic products through
specific work on nerve centres that directly and indirectly reach the lymphatic
nodules and vessels. The text books on antomy so far have given but
meagre information on this great system and the physiologists give us little
to go by in touching upon the function of this subsidiary system of circulation,
that is, in reality, of more significance in some respects than that of
the vascular system conveying the great blood stream.
It is hoped that this little book will be welcomed by those who are students of the human body, as all physicians should be, and that within a few years at the most we can add much to our findings, and record them in a new edition, that will be much larger and more complete. In making the original drawings to illustrate the text, the author has had no precedent, in many instances, and has had to rely upon dissections and in some instances autopsies. In time we may find that we have only touched this great subject, but we will present as best we can our findings thus far, and only hope that at some future date we may understand more fully a system that deals so directly with diseased conditions, and is so closely allied with all pathological phases. We will try and not cover the ground that anatomists so far have outlined , but will deal as directly as possible with the more important phase namely, the applied anatomy of the lymphatic system. We wish to express our indebtedness to Drs. Bush, Edwards, Forbes, Deason, Collins, Reid, Muttart, Snyder, Ruddy, Moore, Downing. Ashley and Bailey for their assistance in making this book instructive and original; and to Dr. A. G. Walmsley for editing the book. To Miss Logier we wish to add our appreciation for assisting in making water washes of the original drawings I have made in order that half tones might be used to clarify the text. F. P. MILLARD, D. O. Toronto,
Outside of surgical references, very little has been written on this subject. The references found pertain to nodes being involved in cancerous conditions, and the spreading of the disease to adjacent nodes and channels, but we have to deal in ordinary practice with nodular involvement relative to disorders not necessarily of a malignant, specific or tubercular nature. The majority of disturbances and organic involvements, from colds to fevers, have a bearing upon the lymphatic system, as it is quite impossible to consider any organic disturbance that does not include a lymphatic change. Viewing the lymphatic system in its entirety, as a complete system within itself, we may be surprised when we recall its important relationship to almost every tissue and organ. Just for a moment separate, in your mind, this system from the vascular and see how complete it is. The part the lymphatic system plays in its close relationship to the tissues in nourishment, assimilation, secretion, and elimination or purificaton, the part this system plays in infected areas, and the immediate activities of the nodes and channels whether a finger is cut or a heel bruised, the long tinted lines on the arm when blood poison has started through an infected abrasion of finger or hand, the checking up and collecting of septic materials that help to prevent sudden poisoning, and greatest of all the necessity of perfect vascular normality to assist the lymphatics functioning better under stress. The vasomotor arrangement in relation to the nodes and large ducts, and the nerve centres from which impulses come are included in this picture of the complexity of this wonderful system. We can but touch the bare outline in a book of this size, but we hope within a few years to have worked out a more or less complete applied analysis of the disturbances and relations of the lymphatic system to the muscles, ligaments and organs that are closely associated with them. In the head and neck alone there are numerous disturbances that reveal lymphatic disorders, when we pause to think of the relations of the lymphatic nodes and channels that become involved through lesions of an osseous nature. There are few areas that have no lymphatics, very few. The lymphatic system completely separated from the body would be an amazing spectacle. Sensitive to a degree, and carrying diseased nodular infection ofttimes without enlargement of palpable significance, this system is more or less constantly charged with infectious material or septic poisoning. The function, in part, of this system is to purify or clarify the contents of its nodules, channels and ducts. The enlarged nodes are often at a distance from the
point of infected abrasion or tissue poisoning.
The unstable vasomotors through lesions, congestion or thickened tissues, throw upon the lymphatics great responsibilities. Organic irregularities cause this system to become more or less blocked and taxed from the points of infection to the termination of the ducts. The regurgitations often referred to in gastric and other organic centres spell systemic symptoms and tissue derangements. In previous articles in the A.O.A. Journal we have pointed out the value of associating enlarged nodes, through palpation, with adjacent or even distant sources of tissue or organic infection. The blisters on the heels, or soft corns, and inter-phalangeal abrasions that invariably cause popliteal lymphatic enlargement, usually with tenderness, are examples. Sometimes even the inquinal glands are noticeably involved, as careful palpation reveals. We used to consider femoral and inguinal nodular enlargements due to pelvic congestion or venereal troubles, but when we remember that this region is the drainage point for all points below, we have to admit the possibility of pedal infection involving these nodes. Likewise, in hand or finger abrasions with infection, we may notice a glandular involvement of the axillary nodes, and in some instances the cervical. This may arouse suspicion regarding the mammary region, but not necessarily, although a secondary disturbance may involve the pectoral region. When the axillary nodes are readily palpable it will be well to examine each finger and thumb around the nail and its matrix, also between the fingers, to see if anything from a cuticle abrasion to interdigital cracks are present in the skin. Any source of infection should be handled immediately to prevent strain upon the lymphatic system that is usually already burdened in the ordinary system. Few people are in such good health that they have normal lymphatic channels and lymphatic fluid. Every abrasion of the skin, every abscessed tooth, every diseased tonsil, sluggish organ and congested area means a more or less irritated and overburdened lymphatic stream. Minimize this strain and teach patients the importance of keeping the skin free from abrasions. Many a system has been taxed by repeated manicures when a careless person has left the cuticle bleeding or raw. We have all seen cases where the fingers were a bit swollen and angry looking from too close cutting of the cuticle or tearing-out of a “hang nail.” Slivers allowed to fester tax the lymphatic system in that region. Absorption following abrasions is always constant and present, and a cat or dog scratch may show up at distant nodes and cause a systemic poisoning that may produce anorexia or nausea, if not more serious result. There are no such things as trifles in the way of abrasions. Septic poisoning even in a small degree may follow. Some are heedless to abrasions and only laugh at them, and give them no attention. Little has been written upon this subject for the lay mind and therefore a lot of systemic disorders have gone by unnoticed. It is only when evidences of blood poison are noticed that people begin to think of the seriousness of an infected abrasion. To my mind, proper care of the skin is most significant if the body is to be kept up to a normal standard. Fortunately, gum boils are no longer laughed at or scorned, but people have their teeth X-rayed, thanks to progressive dentists and physicians. In the following chapters we intend taking up the applied references to 1st, the head and neck; 2nd, the region of the intercostals, and 3rd, the abdominal and pelvic regions. We illustrate these chapters with original drawings. The Editor
It has been my privilege to be closely associated with Dr. Millard and his work for a number of years. Six or more years ago, before he had written on the subject of Lymphatics, he outlined to me his theories of lymphatic diagnosis in certain pathological conditions. At first the thought was new and I was inclined to be skeptical, but as the subject opened up I began to see the logic of the theory. Since then Dr. Millard has given much time to the study of the lymphatic system and this work is the outcome of his studies and researches. The first five chapters of the book are by Dr. Millard. In these chapters the applied anatomy of the lymphatic system is discussed in the various parts of the body. These chapters merit careful study, not only because they present many valuable thoughts on the subject under discussion, but because they lay the foundation for a better understanding and appreciation of the thought presented in later chapters by other writers. Dr. Millard’s penchant for illustrating his writing, and the attractive, convincing manner in which he does it, has always made his writings highly acceptable to the profession. In the present volume no effort nor expense has been spared in this respect, and the value of the work is greatly enhanced because of the graphic manner in which it is illustrated. While the title of the work is Applied Anatomy of the Lymphatics, it contains so much new and valuable data on the treatment of the lymphatics that no busy and progressive practicianer can afford to be without it. Some of the specialists who contribute to the work devote as much or more attention to a discussion of treatment as they do to anatomy, but it is worthy of note that in every instance they first review the anatomy of the part in order that they may emphasize the anatomical reasons for the treatment outlined. In bringing out this work, it is not claimed that the last word has been said on the subject presented, or on any phase of the subject. It is in the nature of research work, and it is hoped from time to time to add new facts to our knowledge of the lymphatic system. A glance at the chapter headings may create the impression that there is much repetition in the work, but this is not so. Each writer presents his subject in a different way, and each writer brings out and emphasizes facts not brought out by the other writers. The attitude of the average physician toward the subject of lymphatics is one of allofness. It is too intricate for him; it would require more study than he could afford to devote to it, he thinks. Now, this is not so; it only SEEMS so. I am happy to say that the subject as presented in this book is not only easy to understand, it is simple and attractive. Indeed, the subject is so attractively presented that the physician in perusing it will be doubly repaid in that he will, while being edified on the subject of lymphatics, at the same time get a splendid review of general anatomy. The past few years have witnessed what might almost be termed a revival of faith or belief in the principles on which the science of Osteopathy is founded. There were those who faltered, who were carried awaya by the siren call of other systems, especially the drug system. This, really, was a passing phase in our professional and scientific growth, a sort of “growing pain.”: The underlying reason for such defections is that many of our profession spend much time delving into medical texts and little time pondering the writings of the founder of Osteopathy and of other capable writers in our ranks. It is well to know medical theory, but if we would attain the highest measure of success in our practice, we must be firmly grounded in the osteopahyic theory and the application of that theory. To accomplish this we must study osteopathic books. The osteopathic physician who will study this work, Applied Anatomy of the Lymphatics, will understand better than ever before why he succeeds in certain types of cases where other systems fail; he will understand better why Osteopahy is so successful in handling acute diseases; he may understand why he has, in the past, secured results in certain conditions without knowing just why results were secured. Applied Anatomy of the Lymphatics is osteopathic through and through. In many pathologic conditions it tells us what to do, and, what is equally important, it also tells us what NOT to do. This book should be in the hands of every physician in practice and every student in our colleges. It is not only a worthy contribution to our literature, it also marks another milestone in osteopathic progress. A. G. WALMSLEY, D. O. Bethlehem, Pennsylvania,
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